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In his revision of psychoanalytic theory (Brenner, 1953); (Arlow & Brenner, 1964) Brenner turns his attention to a highly important area.
To start with depression: Brenner (this issue) challenges the view that depression is a diagnostic category, an illness per se, and, with a series of arguments, proposes to regard it only as a configuration of symptoms which may originate at any period of development, but do so most frequently at the phallic–oedipal stage.
He challenges those who hold that depression is an illness to produce proof for their view.
I do not claim to produce such proof. But, agreeing with Brenner that clinical observation alone should guide our theories, I shall present some clinical material, a diagnostic interview, to show why I am sure that depression is an illness, while remaining unsure sometimes whether in a given case this illness will prove to be neurotic or psychotic, or a phase in a schizophrenic patient. (For a careful exploration of the differential diagnosis between depression and schizophrenia, see Jacobson, 1971.)
A few words about the difference between symptoms and illness, although I am restating what is familiar.
One of Freud's major contributions to psychology lies in his discovery that the frontiers between mental health and illness are not as hard and fast as was thought at his time. However, this understanding of psychic life does not demolish the concept of psychic illness.
We are all prone at times to be depressed or manic ('basic ego states': Lewin, 1965); (Bibring, 1953); (Mahler, 1969, and others), to react in a paranoid fashion, have a delusional idea or a hallucination, stay rooted to the spot, lost in nothingness, etc. These transitory symptomatic states do not mark us as suffering from manic-depressive illness nor from paranoid catatonic schizophrenia. (It would be interesting but lead us away from the present topic to follow the links with parapraxes.)
What decides the issue between health and illness is the intensity